Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is subdivided based on the site of involvement within the main pancreatic duct (MPD) as follows: the main duct (MD), the branch duct, or a mixture of the two.Surgical resection is strongly recommended for MD-IPMNs because of their high malignant potential.In a previous surgical series, the malignancy rate of MD-IPMN was 36-100%. 1 However, this may be an overestimation of the actual risk.Surgical series can present selection bias, as patients who undergo surgical resection are more likely to present with criteria suspicious for progression.The international consensus guidelines for managing IPMN recommend resecting all MD-IPMNs with an MPD diameter > 10 mm, jaundice, or mural nodules. 1 Mural nodules have been established as a predictor of malignancy in MD-IPMNs, with high sensitivity (59-92%) and specificity (60-96%).[2][3][4] However, all MD-IPMNs are not diagnosed to be malignant, despite being surgically resected using these criteria.